allo-hsct vs asct in adult t-lbl

Conditions: T Lymphoblastic Lymphoma

Summary: autologous hematopoietic stem cell transplantation (asct) is the important consolidation for adult t-lbl. allogeneic hematopoietic stem cell transplantation (allo-hsct) is also the important consolidation for adult t-lbl. so asct vs allo-hsct: which is better consolidation for adult t-lbl?

1. characteristics of adult t-lymphoblastic lymphoma (t-lbl) t-lymphoblastic lymphoma (t-lbl) is a highly aggressive lymphoma which shares biological and morphological features with t-cell acute lymphoblastic leukemia (t-all), and t-lbl is conventionally distinguished from t-all by less than 25% bone marrow (bm) infiltrating blasts cells. t-lbl only represents 3-4% of adult's non-hodgkin lymphomas (nhl) which is a rare histologic subtype of nhl in adults. for this reason, few studies had focused on the disease-specific cohort of adult t-lbl patients and most of the studies included both t-lbl and t-all. 2. autologous hematopoietic stem cell transplantation (asct) is the important consolidation for adult t-lbl the treatment paradigm of t-lbl is evolving. in the 1980s, when patients were treated with lymphoma-like regimens, the outcome of t-lbl was dismal and the 5-year progression-free survival (pfs) and overall survival (os) was only 22% and 32%, respectively. all-like regimens significantly increase the complete response (cr) rate to more than 90% in t-lbl patients; however, disease relapse negatively impacts the long-term survival. for example, the 3-year os rates of t-lbl could be as high as 66.9% to 70% while the 5-year os rates decrease to below 50% in adults. asct is an important consolidation for adult t-lbl, which could also improve the survival of t-lbl compared with those only receiving chemotherapy. however, for patients with some risk factors (such as central nervous system \[cns\] involvement or bone marrow \[bm\] involvement), the survival was very poor. in addition, asct is associated with a significantly higher risk of disease progression or recurrence. 3. allogeneic hematopoietic stem cell transplantation (allo-hsct) is also the important consolidation for adult t-lbl allogeneic hematopoietic stem cell transplantation (allo-hsct) is one of the most important curative treatments for t-lbl mainly because of the graft-versus-lymphoma effect, particularly for those with high-risk characteristics of relapse. recently, in a multicenter study of china enrolled 130 ann-arbor stage iii or iv t-lbl patients (\> 16 years) treated with allo-hsct, the 2-year probabilities of disease progression, pfs, os and nrm after allo-hsct were 21.0%, 69.8%, 79.5%, and 9.2%, respectively. patients with cns involvement had a higher cumulative incidence of disease progression compared with those without cns involvement (57.1% vs. 18.9%, p = 0.014). patients receiving allo-hsct in non-remission (nr) had a poorer pfs compared with those receiving allo-hsct in complete remission (cr) or partial remission (pr) (49.2% vs. 72.7%, p = 0.041). particularly, for patients with bm involvement and achieving cr before allo-hsct, measurable residual disease (mrd) positivity before allo-hsct was associated with a poorer pfs compared with mrd negativity (62.7% vs. 86.8 %, hr 1.94, p = 0.036). thus, this real-world data suggested that allo-hsct appeared to be an effective therapy for adults t-lbl patients with ann-arbor stage iii or iv disease. 4. asct vs allo-hsct: which is better consolidation for adult t-lbl thus far, whether allo-hsct could be superior to asct as consolidation in t-lbl was unknown, which should be identified by randomized controlled trials.

Eligibility criteria:
inclusion criteria: * 1) newly diagnosed t-lbl; 2) 18-65 years of age at the time of diagnosis; 3) categorized into ann-arbor stage iii or iv; 4) achieving complete response (cr) after 3 courses of induction chemotherapies; 5) ecog ps score 0 or 1; 6) it needs consent from the patients or/and legal guardian, and signature on the informed consent. exclusion criteria: * 1) newly diagnosed t-lbl, but categorized into ann-arbor stage i or ii; 2) \ 25% bm involvement or \> 5% lymphoma cells in the peripheral blood; 5) ecog ps score of 2 or more; 6) patients with other comorbidities or mental diseases that influence the life safety and compliance of patients as well as affect informed consent, enrollment in the research, follow-up visit or result interpretation.

Keywords: allogeneic hematopoietic stem cell transplantation autologous hematopoietic stem cell transplantation t lymphoblastic lymphoma